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Reversal by medical treatment of endometrial hyperplasia caused by estrogen replacement therapy

Figueroa-Casas, Pedro R. MD; Ettinger, Bruce MD; Delgado, Ernesto MD; Javkin, Adriana MD; Vieder, Claudia MD

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Objective Endometrial hyperplasia, an entity considered a precursor to endometrial carcinoma, frequently develops in women receiving unopposed estrogens. Progestins used concomitantly with estrogens can largely prevent endometrial hyperplasia and carcinoma. However, the ability of progestins to reverse endometrial hyperplasia induced by estrogens is less well recognized. The purpose of this study was to assess the medical reversal rate of endometrial hyperplasia that develops in women receiving unopposed estrogen replacement therapy (ERT).

Design Review of recent literature (1990–2000).

Results Based on four large series, more than 90% of endometrial hyperplasia caused by ERT can be reversed by medical treatment. Discontinuation of estrogen and oral administration of 10 mg/day of medroxyprogesterone acetate continuously for 6 weeks or cyclically for 3 months (2 weeks of each month) are the two regimens most widely used. Other progestins also have been shown to be effective.

Conclusions Progestins are highly successful in reversing endometrial hyperplasia caused by ERT.

From the 1 Department of Gynecology, Hospital Saenz-Pena, Rosario, Argentina, and the 2 Division of Research, Kaiser Permanente Medical Care Program, Oakland, CA, USA.

Received July 5, 2000;

revised and accepted May 15, 2001.

Address reprint requests to Pedro Figueroa-Casas, MD, Mendoza 2282, Rosario 2000, Argentina. E-mail: pfigueroa@arnet.com.ar.

© 2001 by The North American Menopause Society.